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Page 14 of 16 Tejiram et al. Plast Aesthet Res. 2025;12:9 https://dx.doi.org/10.20517/2347-9264.2024.109

relationship between preoperative antibiotics, the microbiome, and infection. Additionally, these findings
are specific to burn-injured patients and are not generalizable to other specific or general patient
populations. Furthermore, there are many methods of microorganism identification, such as biopsies for the
detection of deep-colonized species. Unfortunately, biopsies are unable to be obtained due to the
preliminary nature of the study and, as such, represent a limitation of the study. Broader and combined
antibiotic regimens are also used in burn-injured patients and are not represented in this microbiome
analysis. All patients were assumed to receive center-specific standard burn care treatment and differences
in clinical care were not accounted for if they occurred. Longitudinal characterization of clinical outcomes,
taken months to years after initial presentation, could have been important to clinical outcome reporting
and could have also revealed changes or reestablishment of resident flora.

This study demonstrates that a perioperative dose of antibiotics is impactful to the host microbiome in
smaller burns. Responsible administration of antibiotic prophylaxis is important to mitigate the increasing
prevalence of MDRO. Understanding the differing abundant taxa in the oral and wound microbiomes may
inform systemic antibiotics’ impact on the host. Infiltration of extremophiles and pathogens such as
Acinetobacter into the oral and wound microbiome suggests augmenting antimicrobial usage to specific
pathogens and only when needed. Further research involving additional bacterial sequencing or probiotic
pre-treatment to reintroduce helpful commensal microorganisms may help to understand the mechanisms
of the wound microbiome.

DECLARATIONS
Authors’ contributions
Wrote the manuscript: Tejiram S, Keyloun JW, Oliver MA, Chen See JR, Pinto DN
Collected clinical samples, conducted lab assays, and analyzed the data: Keyloun JW, Ball RL
Conducted lab assays and analyzed the data: Oliver MA
Analyzed and interpreted the data: Wright J
Contributed to project conception and protocolization: Nosanov L, McLawhorn MM
Contributed to the analysis and interpretation of data: Lamendella R
Contributed to the editing and revision of the manuscript: Tejiram S, Keyloun JW, Carney BC, Travis TE,
Moffatt LT, Shupp JW
Conceived the project, contributed to the analysis and interpretation of data, and edited and revised the
manuscript: Shupp JW

Availability of data and materials
The authors confirm that the data supporting the findings of this study are available within the article or
from the corresponding author upon reasonable request.

Financial support and sponsorship
None.

Conflicts of interest
All authors declared that there are no conflicts of interest.

Ethical approval and consent to participate
The protocol was approved by Medstar Health Research Institute’s Institutional Review Board (Protocol
#2017-186). Informed consent was obtained before study participation.